Bruises (Ecchymosis)

What is a bruise (ecchymosis)?

“Ecchymosis” (pronounced “eh-chuh-mow-sis”) is the medical term for a bruise. A bruise, or contusion, is skin discoloration from damaged, leaking blood vessels underneath your skin. Even though there’s blood pooling underneath your skin, you won’t have any external bleeding unless your skin breaks open.

The collection of blood makes a bruise visible. Bruises form a mark on your skin that ranges in color from black, blue, purple, brown or yellow. Your body’s blood cells repair damaged blood vessels to help you heal.

What are other similar types of bleeding?

There are several types of bleeding that cause skin discoloration, including:

• Hematoma: Trauma, such as a car accident or major fall, can cause a hematoma. A hematoma is a larger collection of blood outside of blood vessels that’s typically raised and causes pain to the touch.
• Petechiae: These are pinpoint areas (less than 2 millimeters) of reddish dots on your skin that don’t turn white after applying gentle pressure.
• Purpura: This is small bleeding under your skin. Purpura are smaller than ecchymosis but larger than petechiae.

Who gets bruises?

Bruises are very common and will affect everyone at some point in their life. Bruises can occur from a fall, accident, sports injury or medical procedure. People older than 65 years are more likely to bruise, along with women and people assigned female at birth.

There are some bleeding disorders and medical conditions that may make you more prone to bruising, including:

• Having cancer or liver disease.
• Having family members who bruise easily.
• Taking medications to thin blood or stop clotting, such as aspirin or blood thinners.
• Regularly taking nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, including ibuprofen (Advil®) or naproxen (Aleve®).
• Having a bleeding disorder such as hemophilia, von Willebrand disease or another blood clotting condition.
• Experiencing a low blood platelet count (thrombocytopenia).
• Having a vitamin C or vitamin K deficiency.

What are the symptoms of a bruise (ecchymosis)?

Bruises range in size, shape and color depending on the type of bruise, cause and location. Symptoms of a bruise include:

• Pain or tenderness (sore feeling) when you touch the bruise.
• Skin discoloration (red to purple, black, brown or yellow).
• Swelling or a raised bump on your skin (hematoma).

What color are bruises?

Bruises are sometimes called black-and-blue marks. They may appear red or purplish at first. If you have a darker skin tone, you may notice purple, dark brown or black bruising. As the area heals, the bruise may turn a lighter shade of brown, green or yellow.

What causes bruises (ecchymosis)?

Broken blood vessels cause bruises to form on your skin. Blood vessels are tubes that carry blood throughout your body. Blood vessels can break or leak like a cracked pipe. This causes blood to seep out of your blood vessel and pool underneath your skin, as there isn’t an opening (wound) for your blood to get out of your body. The pooling of blood causes a visible sign of a bruise on your skin (skin discoloration). Your blood cells (platelets) are your body’s plumbers to repair the leak in your blood vessels. Platelets stop bleeding within your body to heal your bruise.

There are several ways that your blood vessels could break, including:

• An injury or physical trauma to your body.
• Aging skin.
• A symptom of taking a medication (like anticoagulants, antiplatelet medicine, aspirin or steroids).
• Having a condition or receiving treatment that affects your blood platelet count (such as autoimmune diseases, leukemia or hemophilia).

How are bruises (ecchymosis) diagnosed?

You and your healthcare provider can identify a bruise by your symptoms, especially the look and color of the mark on your skin. Your provider can further identify what type of ecchymosis you have based on your symptoms.

If you experience frequent or unexplained bruising, your provider may order tests to rule out possible causes. These tests include:

• X-ray to check for bone fractures.
• Blood tests to check for clotting conditions and vitamin deficiencies.

How are bruises (ecchymosis) treated?

Most bruises fade away and don’t need treatment. More severe bruises might need treatment. You can help your bruises heal faster by:

• Resting and elevating the injured area to prevent swelling and to relieve pain.
• Applying ice packs for the first 24 to 48 hours after injury. Wrap the ice pack in a towel and apply ice for no more than 15 minutes at a time. Repeat throughout the day.
• Applying a heating pad or warm compress to the injured area after two days. You can apply heat several times throughout the day.
• Taking over-the-counter pain medication, such as acetaminophen. Check with your provider before using NSAIDs.

How can I prevent bruises (ecchymosis)?

Everyone experiences bruising. You can take these steps to lower your risk of injury and bruising by:

• Keeping floors and rooms clear of tripping hazards.
• Moving furniture away from doorways and walkways to avoid bumping into hard surfaces.
• Turning on a light or flashlight when walking through poorly lit areas.
• Getting enough vitamins in your diet.
• Wearing protective gear like helmets and pads when playing contact sports, bicycling or riding a motorcycle.

What can I expect if I have a bruise (ecchymosis)?

Bruises can be unsightly, but most bruises fade without treatment. Sometimes, bruising is a sign of a more serious issue, so talk to a healthcare provider if you experience unexplained or large bruises. Certain types of bruises, such as hematomas, may require medical attention.

How long do bruises last?

The length of time you’ll have a bruise varies based on what caused your bruise and the type of bruise. Most bruises fade away within two weeks without treatment. More severe bruising and hematomas may last a month or longer.

When should I see my healthcare provider about a bruise?

You should call a healthcare provider if you experience:

• A black eye with vision problems.
• Bruising that lasts more than two weeks.
• Frequent, large bruises.
• A lump in the bruised area (hematoma).
• Painful swelling.
• Pain that lingers days after the injury.
• A recurring bruise in the same location.
• Unexplained bruising.
• Unusual bleeding, such as nosebleeds, blood in your pee or blood with bowel movements.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• What’s causing the bruising?
• Why am I prone to bruising?
• Should I have blood tests to see if a condition is causing the bruises?
• What steps can I take to lower my risk of bruising?
• Should I look out for signs of complications?

What is the ICD for ecchymosis?

The International Classification of Diseases (ICD) is a tool for healthcare providers to diagnose and classify conditions for clinical settings. The ICD-10-CM code for ecchymosis is R58.

A note from Cleveland Clinic

Ecchymosis (bruising) is a common condition that affects everyone at some point. You should see your healthcare provider if you seem to bruise easily or have unexplained bruising. They’ll want to rule out certain conditions that may require treatment. Applying ice soon after an injury can minimize bruising. Most bruises go away without treatment within a couple of weeks.